J Korean Med Sci.  2010 May;25(5):790-793. 10.3346/jkms.2010.25.5.790.

Laparoscopic Total Mesorectal Excision in a Rectal Cancer Patient with Situs Inversus Totalis

• Huh JW
• Kim HR
• Cho SH
• Kim CY
• Kim HJ
• Joo JK
• Kim YJ

• KMID: 1713968
• DOI: http://doi.org/10.3346/jkms.2010.25.5.790

Abstract

Situs inversus totalis is a rare anomaly in which the abdominal and thoracic cavity structures are opposite their usual positions. A 41-yr-old woman, who had an ulcerating cancer on the rectum, was found as a case of situs inversus totalis. We present an overview of the operative technique for the first documented laparoscopic total mesorectal excision of a rectal cancer in the patient with situs inversus totalis. Careful consideration of the mirror-image anatomy permitted a safe operation using techniques not otherwise different from those used for the general population. Therefore, curative laparoscopic surgery for rectal cancer in this patient is feasible and safe.

Keyword

Situs Inversus; Rectal Neoplasms; Laparoscopy

MeSH Terms

Adult
Female
Humans
Laparoscopy/*methods
Mesocolon/*surgery
Rectal Neoplasms/diagnosis/*surgery
Rectum/*surgery
Situs Inversus/*complications/*surgery

Figure

• 

  Fig. 1 Chest X-ray showing dextrocardia and a right subphrenic gastric bubble.

• 

  Fig. 2 Computed tomography disclosing complete transposition of the abdominal viscera: (A) coronal view and (B) axial view.

• 

  Fig. 3 Origin of the inferior mesenteric artery (IMA) from the right side of the abdominal aorta. CIA, common iliac artery.

• 

  Fig. 4 Division of the inferior mesenteric artery at its origin.

• 

  Fig. 5 Division of the inferior mesenteric vein and left (actually right side) colic artery.

• 

  Fig. 6 Full mobilization of the splenic flexure.

• 

  Fig. 7 Extracorporeal extraction of the specimen through a 12-mm port in the right lower quadrant of the abdomen.

• 

  Fig. 8 Intracorporeal anastomosis using the EEA stapler (CDH29®; Ethicon Endo-Surgery Inc., Cincinnati, OH, USA).

• 

  Fig. 9 The rectal cancer specimen.

Reference

1. Nursal TZ, Baykal A, Iret D, Aran O. Laparoscopic cholecystectomy in a patient with situs inversus totalis. J Laparoendosc Adv Surg Tech A. 2001. 11:239–241.

2. Kobus C, Targarona EM, Bendahan GE, Alonso V, Balague C, Vela S, Garriga J, Trias M. Laparoscopic surgery in situs inversus: a literature review and a report of laparoscopic sigmoidectomy for diverticulitis in situs inversus. Langenbecks Arch Surg. 2004. 389:396–399.

3. Fujiwara Y, Fukunaga Y, Higashino M, Tanimura S, Takemura M, Tanaka Y, Osugi H. Laparoscopic hemicolectomy in a patient with situs inversus totalis. World J Gastroenterol. 2007. 13:5035–5037.

4. Jobanputra S, Safar B, Wexner SD. Laparoscopic diverticular resection with situs inversus totalis (SIT): report of a case. Surg Innov. 2007. 14:284–286.

5. Davies H, Slater GH, Bailey M. Laparascopic sigmoid colectomy for diverticular disease in a patient with situs inversus. Surg Endosc. 2003. 17:160–161.

6. Oms LM, Badia JM. Laparoscopic cholecystectomy in situs inversus totalis: the importance of being left-handed. Surg Endosc. 2003. 17:1859–1861.

7. Al-Jumaily M, Hoche F. Laparoscopic cholecystectomy in situs inversus totalis: is it safe? J Laparoendosc Adv Surg Tech A. 2001. 11:229–231.

8. Machado NO, Chopra P. Laparoscopic cholecystectomy in a patient with situs inversus totalis: feasibility and technical difficulties. JSLS. 2006. 10:386–391.

9. Yamaguchi S, Orita H, Yamaoka T, Mii S, Sakata H, Hashizume M. Laparoscope-assisted distal gastrectomy for early gastric cancer in a 76-year-old man with situs inversus totalis. Surg Endosc. 2003. 17:352–353.

10. Wittgrove AC, Clark GW. Laparoscopic gastric bypass for morbid obesity in a patient with situs inversus. J Laparoendosc Adv Surg Tech A. 1998. 8:53–55.

11. Iwamura T, Shibata N, Haraguchi Y, Hisashi Y, Nishikawa T, Yamada H, Hayashi T, Toyoda K. Synchronous double cancer of the stomach and rectum with situs inversus totalis and polysplenia syndrome. J Clin Gastroenterol. 2001. 33:148–153.